Catholic Health Initiatives Patient Account Rep II - Physician Billing Office in DES MOINES, Iowa

Patient Account Rep II - Physician Billing Office

Description

GENERAL SUMMARY :

Adhere to corporate policies and procedures as dictated by the specific job. Ability to interpret explanation of benefits and correspondence from multiple payers. Contact payers, patients, or clinics to resolve claim issues. Work accounts as dictated by the specific job. Is knowledgeable with insurance carriers’ policies and procedures. Adhere to all productivity expectations and quality assurance standards. Provide excellent customer service consistent with Mercy’s philosophy and guidelines.

ESSENTIAL FUNCTIONS :

Follow-up

  • Responsible for reviewing, correcting and filing unpaid or previously adjudicated claims as assigned

  • Contacts insurance carriers, patients, and clinics to resolve claim issues.

  • Participates in recognizing denial trends and provides feedback to manager

Credit Balance (Insurance):

  • Research and resolve all insurance/business overpayments

  • Maintain knowledge of payment posting and follow-up processes

  • Review and respond to carrier correspondence requesting refunds

Credit Balance (Patient):

  • Research and resolve all patient credit balances

  • Communicate with guarantors and patients regarding questions related to patient refunds.

  • Works unassigned payment queues and reports.

Cash/Zero Pay Posting

  • Responsible for the posting of all assigned cash payments, adjustments and remark codes,

  • Reconciles and balances all batches.

  • Contacts payers to resolve issues necessary in order to reconcile, apply payments, and bring variances to resolution.

Customer Service:

  • Manages large amount of incoming calls and assists walk in customers

  • Handles customer complaints, provides appropriate solutions within time limits, and follows up to ensure resolution .

  • Follows communication procedures, guidelines and policies.

Collections:

  • Reviews and moves accounts through the pre-collection process before placing with collection agency

  • Handles inbound and outbound collection calls.

  • Is responsible for all bad address and legal correspondence, probates, and bankruptcy

Financial Assistance:

  • Reviews all applications to determine if the account qualifies for charity

  • Is knowledgeable and adheres to the CHI Financial Assistance policy

Qualifications

MINIMUM KNOWLEDGE, SKILLSAND ABILITIES REQUIRED :

  • High schooldiploma or GED required.

  • One yearexperience in accounts receivable, banking, or office setting required.

  • A minimum of one yearcurrent experience of CPT, ICD-10, and HCFA 1500 preferred.

  • Successful completion of amedical terminology class preferred.

  • One year 10 keyexperience preferred.

  • Demonstrates written, verbal, and nonverbal communication that isconsistent with the Mercy Mission, Values and I Will Statements to allpatients, families, visitors, medical staff, colleagues, vendors and otherinternal and external customers.

  • Must be a self- started and demonstrate the ability to workindependently by making appropriate decisions according to the organizationaland departmental guidelines that fall within the scope of the position.

  • Demonstrates the ability to understand and effectively utilize a highlycomplex billing system(s).

  • Maintains current knowledge of all Federal, State and complianceregulations related to billing and insurance preferred.

  • Demonstrates an understanding of HCFA 1500 claim forms, CPT, ICD.9 andHCPCS codes specific to insurance carrier requirements preferred.

Job Administrative/Clerical

Primary Location IOWA-DES MOINES-MERCY MEDICAL CENTER

Daily Schedule Days

Scheduled Hours per 2-week Pay Period 80

Weekends Required None

Req ID: 2018-R0175938

We’re an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.